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The value of working with Aging Life Care Professionals

September 12, 2017

Improving the quality of life for our elders and aging families is our passion and mission. This article, The Value of Working with Aging Life Care Professionals  from the Aging Life Care Association Florida chapter, summarizes their research conducted with their clients/families. It heartens us to receive valuable feedback like the information in this article.

Shower assistance for people living with dementia

May 08, 2017

Maya Angelou quoteSupport for activities of daily living (eating, bathing, toileting, dressing, ambulating) looks different for every caregiver-care partner engagement. The partnership is rarely a 50-50 interaction. As human beings we transact differently depending on relationships. Successful provision of care for someone living with dementia is the result of a caregiver leaving his/her “my way or the highway” mindset at the door.

What is one of the most challenging interactions caregivers and care partners face? “It’s time for a shower.” Let’s break it down.

  • It is embarrassing to strip naked in front of another person.
  • Being naked means feeling cold. Feeling cold is uncomfortable.
  • Water temperature is easily too cold or too hot.
  • Adults don’t need shower assistance. Adults with dementia still believe they should bathe in private.
  • Soap and water can make eyes hurt and sting.
  • Wet floors are slippery. Falls happen.

The best case scenario for the care recipient is that he/she is at home in familiar surroundings. The bathroom is small, cozy and easy to heat with soft towels, fragrant soap, non-slip bath mats, and lights that can be dimmed or brightened.

The worst case scenario – I saw it and experienced it firsthand last week with my client. We were in a memory care unit. My client’s bathroom does not have a bath or shower for safety reasons. To take a shower, think old school college dorm bathroom at the end of the hall. Think how overwhelming it must feel at age 80+ to be led from a familiar space to a door that an aide has to unlock. The room is sterile with a strange looking bathtub and a shower stall with no door or curtain. No bath mat, no fragrant soap, no fluffy brightly colored towels in sight. And an aide, someone you don’t recognize, tells you to get undressed. Where is your laundry hamper? Where is anything that looks familiar and inviting? Of course my client refused shower assistance.

No wonder our loved ones with dementia don’t want to shower. Actually I think they may but in their own time, in their own way, in their own space (in a home where they lived a long time ago), with Mom, not an aide, nearby.

Long-term care residential facilities and corporations, I challenge you. Up your game. Think outside the box. In the name of “shower assistance” make small but meaningful changes behind that locked “spa” door. And for heaven’s sake, stop calling that cold, impersonal room a spa. I was in that space last week. That definitely was not a spa. Allocate enough of an aide’s time that the shower won’t be rushed. Coach that aide to be respectful and patient and gentle. Use color, soft textures, fragrance, a gentle touch and a quiet voice. I want our elders, not senior living corporations, to win this battle.

Sibling rivalry, aging parents and running the emotional gauntlet

March 07, 2017

sibling rivalrySibling rivalry, also known as competition between sisters and brothers for a parent’s attention, may change over time. Unique relationships can strengthen or weaken on the road from childhood to adulthood.

Birth order can create lifelong labels that defy age, education, and experience. With that status often come a pre-defined set of roles. As Jane Mersky Leder wrote: “our siblings push buttons that cast us in roles we felt sure we had let go of long ago — the baby, the peacekeeper, the caretaker, the avoider. It doesn’t seem to matter how much time has elapsed or how far we’ve traveled.”

Often when adult siblings receive a crisis alert that elderly Mom or Dad is sick, it is common for old roles to flare. How quickly an adult child can revert into acting like a kid when siblings get together. There is just something about being with brothers and sisters that invokes time travel, from age 45 to age 5 in a snap, and subsequently, from mature to immature. A thin line exists between sibling love and sibling rivalry.

Family dynamics are a powerful force, and when combined with the stress and fear of losing a parent, can launch (or re-start) sibling rivalry. How adult children navigate the stormy times with an older or younger sibling depends on many factors including his or her own support system, self-awareness, dedication to a greater good and emotional maturity – easy to say, hard to implement and perhaps challenging to stay the course.

Aging parents play a leading role in sibling dynamics. However, it is neither wise nor fair to count on Mom or Dad to mediate their grown up children’s feuds. Adult children need to acknowledge that they may not have had the perfect childhood or the perfect parents. Be aware of the possibility of pitting one child against another, manipulation, and the age old comparison game.

How to avoid sibling rivalry during a parent’s aging journey?

  1. Hope for the best and expect less – less in terms of personal recognition, equity, fame, glory, money, family heirlooms, etc. Aim for selflessness; it is a good look on everyone.
  2. Respect legal and fiduciary assignments that parents have executed via power of attorney documents, wills, trusts, HIPAA release authorizations, etc. whether you personally agree or not. If your parent has not made his wishes clear by executing written advance directives, consult an attorney so your parent can put these essential documents in place.
  3. Jobs for everyone!  Look at the tasks that must be accomplished. Match those tasks with individual strengths. Instead of forcing your brother to stay at the hospital with Mom when everyone knows that he is squeamish, ask him to mow the grass or hire a housekeeper. If you and your siblings cannot reach consensus quickly, phone a friend or a pastor or a family elder or a professional care manager – someone that can help you make assignments without starting a family squabble.
  4. Practice self-care. It is hard to drink from an empty glass. Stress, anxiety, fear are ingredients for a perfect sibling storm. If you are a long distance adult child or if parental love is not the common denominator in your family, send a proxy. Professional care managers are trained to facilitate during a crisis. Care managers often serve as a “surrogate” sibling and can become the glue that holds the family together through the crisis.
  5. Now is not the time. An aging parent emergency is not necessarily the time to give in to family dysfunction and sibling rivalry. Even if a family member is on your last nerve, walk (or run) away from that scene.

The common ground may be love for your parent. Meet there. Even if it’s true that your brother always received more attention, gifts, love, etc., it is bad form to expect your parent to balance the scales during a health crisis.

“The principle needs to be this: Whatever the reasons for your feelings you will have to find civilized solutions.” – Selma Fraiburg


Vitamin D: bring back the sunshine

February 23, 2017

As basic as our need for water, sunlight is an ingredient for healthy bodies and minds. Known as the sunshine vitamin, we produce Vitamin D in response to exposure to sunlight. It is necessary for strong bones. Bone pain and muscle weakness are ways our bodies may reflect a deficiency.

Low blood levels of Vitamin D are also associated with cognitive impairment in older adults, heart disease and cancer.

Vitamin D is a fat soluble vitamin stored in the body so supplement levels should be checked and managed by a healthcare provider. Sitting outside on sunny days for about 10 minutes is an easy way for most people to increase levels naturally.

Working with healthcare providers to monitor Vitamin D levels as we age is good prevention practice. Build bone and muscle, reduce the risk of falls, reduce the incidence of certain cancers and possibly prevent diabetes.

Ongoing research regarding the link between Vitamin D deficiency and dementia offers hope for preventing or delaying onset Alzheimer’s and other forms of dementia. Study results recently published by lead author “David Llewellyn, of the University of Exeter Medical School, concluded that “we expected to find an association between low vitamin D levels and the risk of dementia and Alzheimer’s disease, but the results were surprising – we actually found that the association was twice as strong as we anticipated.” The study showed a strong link between dementia and a Vitamin D deficiency, but researchers are not yet ready to say that a Vitamin D deficiency causes dementia. Clinical trials and further research are needed to establish whether adequate levels of the vitamin can prevent, treat, or delay Alzheimer’s.” (Source, Alzheimers.net)

When the local weather forecast predicts warm, sunny days I encourage my home bound clients and caregivers to spend time outdoors. Enjoying a sunny afternoon outside reaps multiple benefits for our elders: fresh air, a change of scenery, exercise, opportunities to socialize and boost production of the sunshine vitamin.Vitamin D

Patient advocate: why you need one

February 15, 2017

Serving as my client’s patient advocate is one of my most heartfelt responsibilities.

Who has your back if you are admitted to the hospital or need to go to the hospital emergency department (ED)?

Have you heard of running a gauntlet? That’s what a trip to the hospital is like. The complexities of medical insurance, patient rights, privacy and confidentiality, liability, computerized medical records, and billing are, at times, overwhelming.

If my client is admitted to a local hospital I go to her bedside. However, if she gets sick away from home I am still her advocate. I stay in regular contact by phone with nurses, hospitalists, discharge planners and family and friends. From hospital shift changes to hospitalist and specialist consults I am a clear and consistent voice.

As an aging society we all need to identify someone that is willing to be our voice, eyes and  ears should we become too sick to advocate for ourselves. We hope never to need a patient advocate, however, the likelihood is we will.

Identify a designated personal representative. Provide current medical information (and that means routine updates as medications, diagnoses and medical conditions change over time). Share copies of insurance cards (and policies!), a list of known allergies (and what the allergic reactions are), surgical and other medical history as well.

In addition to a patient advocate we need a designated healthcare power of attorney (primary and back-up) that is legally authorized to enact our advance directives when we cannot speak for ourselves. Go to the web for standard healthcare power of attorney forms. Click here for the North Carolina Secretary of State’s website to download healthcare power of attorney forms.

Consider the importance of a living will or a Five Wishes document.

Keep HIPAA authorization forms up to date. Healthcare providers need this written consent to share confidential medical information.

As my client’s patient advocate, I:

  1. Maintain a current medications list that is easily accessed in an emergency.
  2. Maintain a current list of known allergies along with the history of reactions.
  3. Keep copies of advance directives to share with first responders and other healthcare providers.
  4. Serve as an informed listener and note-taker at bedside.
  5. Provide contact information for family/friends as appropriate.
  6. Serve as point of contact for medical updates, questions, etc. to relieve patient and family.
  7. Ask “WHY” questions about medical tests, changes in medications and dosing schedules, planned surgeries/procedures, the discharge plan.
  8. Remind myself, healthcare providers, family and friends what my client’s wishes are
  9. Offer another perspective.
  10. And, always, uphold a patient’s dignity and the right to person-centered care.